In this post I’d like to share my experience of using a little-known ingenious device for supplementing breast milk with formula milk. I haven’t met many mums who have used such a thing, and as far as I can see there isn’t much info out there about it compared to other breastfeeding-related ‘equipment’, so I’m hoping this will be a really informative post for anyone who this might be useful to.

Before I go any further though, let me first talk a bit about low milk supply and the possible need for supplementing with formula. Much of the useful information that I have taken in about breastfeeding has been through La Leche League (LLL), and, more specifically, the book published by the organisation called The Womanly Art of Breastfeeding (which I’ll call WAB for short). The information in this book was written by mums with years of breastfeeding experience, and is backed up by medical professionals and scientific research into various aspects of breastfeeding; plus it is constantly being updated (currently in its 8th edition).

A common anxiety that many mums-to-be and new mums have about breastfeeding is ‘will I (or do I) have enough milk?’ WAB’s answer is that most mums are able to make plenty of milk; some do have difficulty making enough, but often the reasons are fixable if the mum gets the right support and information at the right time. So what might cause a deficient milk supply? WAB puts it like this…. The baby might not be taking enough from the breast (leading to a declining supply because breastfeeding works on the principle of the more milk taken the more is produced); this could be due to issues such as position at the breast, the frequency and length of feedings (not often enough, too short), prematurity, tongue-tie, muscle weakness etc. Or mum might have hormonal issues which lead to lower milk supply, such as thyroid problems, polycystic ovary syndrome and other fertility issues, or structural issues with her breasts, such as previous surgery or insufficient milk-making tissue. There are many possible factors involved, and the combination of factors is different for each breastfeeding pair (mum and baby).

In the case of Andrew and I, there was a mixture of both mum and baby issues which lead to our supply problem (you can read our full story here, but I’ll summarise for you now). I don’t have a huge amount of milk-making tissue, which is evident from the shape and size of my breasts (it is important to note that small breasts does not automatically mean insufficient milk-making tissue, nor indeed does big breasts automatically mean loads of milk-making tissue – there could be lots of fat tissue too which doesn’t make milk; shape is also key in this. For more info, I’d recommend reading p381-382 of WAB or the LLL book Breastfeeding Mother’s Guide to Making More Milk). Also, Andrew was born with a tongue-tie. This was a particularly tricky one to spot, and we didn’t get an official diagnosis until he was nearly 10 weeks old, at which point it was snipped and this did make a difference to his weight gain (the indicator that he was getting more milk).

And finally, before I actually get on to at-breast supplementing after this important deviation into low milk supply, let me mention a few points (from WAB) that might explain why a mum thinks she isn’t making enough milk (when in fact she is). She might not realise that babies need to feed as often and for as long as they do (though they all differ in exact requirements) – what seems like all day every day canbe completely normal. She might have someone else asking her ‘are you sure your baby is getting enough?’ – that’s enough to make any new (or not so new!) mum doubt herself and her instincts. She might not be letting the baby lead the way by letting him/her feed whenever and for however long he/she wants to, and instead following a schedule imposed by herself or a parenting book.

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If you along with your health professionals and breastfeeding supporters have ruled out all the potential causes of low milk supply (actual and perceived), and tried to fix any that could be at play, but baby is still not thriving as he/she should (usually indicated by poor weight gain, at least that’s what medical professionals look for, though there are other things like lethargy, dry mouth/eyes/skin, not reaching milestones), then supplementing baby’s milk intake is a necessity for his/her well-being.

At this point I would like to point out that, despite the impression that some people including medical professionals give, baby feeding does not have to be black and white: either you breast feed (exclusively) or you bottle feed. I successfully combined breastfeeding with formula supplements until Andrew was on a balanced and varied solid food diet, at which point I dropped the formula and continued to breast feed. Don’t let anyone tell you this isn’t possible!!! WAB also makes the same point. Another thing to point out is that there are ways in which mum can try and increase her supply as much as possible, for example by expressing milk to give to baby as well as feeding directly at the breast and taking herbal supplements (I won’t go into this here, but again I’d recommend WAB or Breastfeeding Mother’s Guide to Making More Milk).

One thing that helped us a lot with our supplementing (and increasing my supply as much as possible) was the at-breast supplementer that we were given (and then later bought one of our own) by our local hospital’s infant feeding specialist midwife when Andrew was admitted with dehydration and major weight loss at 6 days old. It’s called a ‘Supplemental Nursing System’, or SNS for short, by Medela. This ingenious device is quite simple really – it’s a bottle, into which formula or expressed breast milk is poured, which hangs around mum’s neck with a thin tube coming out of the bottom that mum sticks to her breast with tape so that the end of the tube sits just on the nipple; when baby sucks on the breast, he/she not only gets all the breast milk available, but also the milk in the bottle via the tube.

SNS (supplemental nursing system) - a bottle that hangs round mummy's neck by a cord, and out of the lid (which is at the bottom when hung) comes a length of thin tubing, which is taped for each feed to the breast, so that the loose end of the tube sits on the nipple. As baby sucks on the nipple, he gets all the mummy milk available, plus the formula in the bottle. Quite ingenious if you ask me!

The reason why I liked this was that Andrew was still breastfeeding all the time that he was also getting the top-up. He did have a bottle every now and then – basically when we were out somewhere that I couldn’t easily prepare and use the SNS – but I would always offer him both breasts first and then the bottle. He didn’t miss out on any of the milk that I was able to make, and I enjoyed the feeling of having him sucking from me and felt like I bonded very well with him in this way. I am convinced that without the SNS we would not still be breastfeeding today, at 16 months! So, ironically, it was a good thing that we went into hospital at 6 days old and were given very good advice by the feeding specialist.

Andrew (4 months) and mummy enjoying a feed, with the SNS around mummy's neck

Sure it was fiddly using the SNS to begin with, and it did take some time to get to know the best ways to use it. Here are some of the things I learnt about what worked for us:

If Andrew was very hungry by the time I got ready to feed him, it was sometimes easier to get him latched on first and then stick the tube in at the side of his mouth, rather than try and latch him on with the tube in place at the nipple, as this often ended up with him knocking it out the way during the latching process! Ideally I tried to feed him when he wasn’t already fussing, but this was sometimes impossible.

As he got older and I found I needed to support him less than in the early days, I found it easier to hold the bottle or put it down next to me instead of having it hanging round my neck which sometimes got in the way when he was bigger.

There are different thicknesses of tube, and working out which one was best at each stage was a process of trial and error: as he got older I thought it was logical to go for thicker tubing to get a faster flow which he could then cope with, but then I realised he got used to that and was more fussy about sucking from me without the SNS (i.e. without the artificial immediate let down of milk), and I reverted to the thinner tubes.

But these issues that we learnt to deal with were nothing compared to the help it gave us, and I would recommend it to anyone who is facing a situation of low supply and the need to top-up. Although we put formula in the SNS (because I was unable to express much with a pump or by hand), it is also possible to put expressed breast milk in it as a way of increasing supply – i.e. you express and baby feeds from you, to maximise the milk output from the breasts.

I’ve tried to remember all the information about low supply and supplementing that I think would be useful for others, but if you have any more specific question, please leave a comment and I’d be happy to tell you more about our experience. For a while I felt like a failure for not being able to produce enough milk and desperately wanted to be able to exclusively breastfeed, but I came (a) to realise that I’m not the only one who struggled with low supply, (b) to accept that this is just the way I and Andrew are (after lots of determined trying to increase supply and put everything right), and (c) to see myself as a breastfeeding mum who gave her baby a bit of calorific help from formula in the early months. Now that Andrew breastfeeds happily without top-ups, but of course a good diet, I’m so happy I persevered through feeling like a failure, because I know now that I most certainly am not! In fact the longer Andrew feeds, the more likely it is that I’ve developed more milk-making tissue to be able to feed the next newborn with less (or no) supplementing. Most of all, I hope that our story inspires others to not feel like a failure when breastfeeding is not going like it does in the textbooks – this is the real world.

Why not hop over to some other blogs and read other mums sharing their experiences? There are some links below, and more on the main website, where you can also find out more about the Keep Britain Breastfeeding Scavenger Hunt 2012. I’m sure there will be lots of other tips and stories to inspire and encourage. Don’t forget to enter the competition below to have a chance of winning the grand prize.

22 Responses to “Mum-to-Mum sharing: at-breast supplementation”

Thanks for sharing, this is something I didn’t know a great deal about so good to read.

My top tip would be to find your local support/peer supporters/breastfeeding group before baby is born so you can get to know them, this makes it much easier to contact them after baby is born; faces to names and voices. It good to know you have support from people who you know and are familiar with and that you trust.

Glad you found it interesting. It’s definitely something that needs more publicity, and I’m doing all I can to do my bit! Great top tip too! I was very lucky to come across my local La Leche League group very early on when we were struggling at the start. They were the best support ever and I’m so glad I found them. I’m now on the committee, and maybe one day I’ll make it as a trained leader, both because I want to give something back to other mums who need support – I’m currently the one who chats to mums who are thinking of using an SNS 😉 I know with baby number 2 I’ll be needing lots of support again, and this time I already have that support network in place, which is great to know!

Thank you for this. We used an SNS too, though I never thought to blog about it. Unfortunately, we managed to melt it whilst sterilising, and by the time the new one arrived I had started using bottles for the supplementation and never got around to using it again. I struggled to use it at first, as baby was a wriggly one and not good at latching, and I found it difficult to poke the tube in. Still bfing at 9months though, with a little supplemental formu?a, and hoping to go for some time yet. I read about a lady who had hypoplasia, like me, and grew more breast tissue through breastfeeding, so her next child was able to get more milk. Fingers crossed 🙂

Wow great to hear from someone else who used one! Also good to know it’s not just us who melted our first in the steriliser!! We got express next-day delivery for the second so didn’t miss out on much time with it though. I struggled at first too, as I said in the post, but in the end we got to know what worked best. I can relate to having a wriggly baby which made latching and tube placing difficult. Over time he came to learn that it was better not to wriggle though. Fantastic that you’re still going at 9 months and beyond – well done 🙂 I never thought I’d get to 16 weeks at one point, let alone 16 months! It is possible with supplementing, despite what some people say. It’s also nice to hear from someone else who has hypoplasia. Again I don’t think there’s much info on it out there, and I was assured at antenatal class that small breasts did not mean I wouldn’t be able to exclusively breastfeed, even though I specifically asked and said I was concerned about my breasts. I was then annoyed when I was eventually properly told about it by lactation consultant who we got for his tongue-tie (another long story!!) But I guess it’s quite a specific thing and it doesn’t always follow that small = hypoplastic. I’ve also read about the fact that the more you feed, the more likely it is that you develop more breast tissue and therefore can feed more with the next baby. Apart from the fact that I love breastfeeding my 16 month old, one of the main reasons I’ve carried on this long is hoping that it will make a difference for our next baby (due in October). Indeed, fingers crossed, for you too 🙂

Absolutely, great tip! I was very lucky to come across my local La Leche League group very early on when we were struggling at the start. They were the best support ever and I’m so glad I found them. I’m now on the committee, and maybe one day I’ll make it as a trained leader, both because I want to give something back to other mums who need support – I’m currently the one who chats to mums who are thinking of using an SNS 😉 I know with baby number 2 I’ll be needing lots of support again, and this time I already have that support network in place, which is great to know!

Persevering is the key! Never give up (no matter how much you want to), tell your husband/partner to not let you give up when you scream that you’ve had enough – you’ll need all the support you can get!! But one day, one day,… It’ll just click, it almost always works out in the end! 🙂

Indeed, partner support is invaluable. My husband has been amazing, even when I was always in floods of tears about it all. I does work out in the end – it took about 6 months for us, but we got there in the end, and still going at 16 months. Not everyone takes that long of course 😉

An inspirational story and what a wonderful little device I never knew existed. I doubted the ability of my small breasts and I realise how fortunate I am to have been able to breastfeed my twins. I am currently training to become a breastfeeding peer support volunteer. You have just opened my eyes to a whole other side to breastfeeding that I knew nothing about. Thank you.
I wish you lot’s of luck with you second baby. x

Thanks for your comment 🙂 Glad you’ve found it useful. I never thought about doing what I did for breastfeeding before I ended up doing it thanks to support I got from local LLL group. I thought if I couldn’t breastfeed completely I’d just have to bottle feed. But I’m so thankful that I found the info and help I needed at the time. My experience has also made me think about training to be peer supporter, not right now with a new baby on the way, but when I feel ready. Hope your training is going well 🙂 x

Wow Ruth i would just like to thankyou for sharing your personal story i oved reading it and found it so informative. I had never heard of this prior to reading your post and find it such a clever and useful idea!

My top tip would be to set yourself up somewere nice and comfy with all of the things you may need as you never know how long you will be there. I used to always have a muslin, drink and a snack to hand with my little girl and plan to do the same when bump decides to arrive 🙂

Thanks Claire 🙂 Glad you found it useful. I’d like to make the most of a difficult situation and see something good come out of our struggles. It’s all good now for us though. Great top tip! Oooh how many weeks is your bump? I’m 20 weeks (scan today).

sorry delayed reaction lol almost 29 weeks now 🙂 not long cant wait (ps loved your scan pic so cute )seems to be going realy fast this time around maybe its running around after a toddler dont have as much time to think , only realy starting to feel it this week.

No worries 🙂 I know what it’s like keeping up with everything! Yes not long now, and I know the feeling of it going fast – I think having a toddler to run around after makes it go quicker too. Hope your weeks to come go really well, if a little fast!

[…] into hospital. She introduced us to the SNS (at-breast supplementer that I talked about in my last post). Without this way of supplementing, with Andrew still getting as much breast milk as I was able to […]

[…] to supplement with formula given my previous breastfeeding experience. Plus they saw me using the SNS (supplemental nursing system) that I’d taken in with us in case we needed it, and could see that Joel was feeding well with […]

[…] Without this ingenious invention, which is actually quite a simple idea, my boys and I wouldn’t still be breastfeeding today. It’s called a Supplemental Nursing System or SNS. It’s a way of supplementing baby with formula or expressed breast milk at the breast rather than with a bottle – Joel has been supplemented since the first week of his life due to my hypoplasia but he has not had a bottle and now he actually refuses to take one just like many breastfed babies do if parents try to introduce bottles around this age You can read more about how it works here. […]

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Everything you see on this blog is copyright of Ruth Cumming, unless otherwise acknowledged. If you'd like to use something you see on here, please get in touch and I'll see what I can do. Thank you! :)
Copyright Ruth Cumming 2012